13 payer leaders' best practices for Medicaid redeterminations

Medicaid continuous coverage requirements are unwinding, and in many states, individuals have lost coverage due to procedural reasons. 

Managed care plans and other organizations are working to communicate with members to make sure as many people eligible for Medicaid stay covered as possible. 

These 13 industry leaders provided their best advice for handling Medicaid redeterminations. The executives featured in this article are all speaking at the Becker's Payer Issues Roundtable, which will take place Nov. 9-10 at the Swissotel in Chicago.

To learn more about this event, click here.

If you would like to join as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.

Question: As continuous coverage requirements unwind, what is one best practice your organization has found for approaching Medicaid redeterminations? 

Don Antonucci. CEO at Providence Health Plan (Portland, Ore.): Helping people navigate the healthcare system, making their experiences less complicated and more personal, is what we always strive for. With Medicaid redetermination, our approach is the same. During this first phase, we're focused on ensuring that those in our communities who are affected by this change have access to clear and reliable information through a wide variety of entry points, so they can confidently move forward in their healthcare journeys.  

Yvonne Collins, MD. Chief Medical Officer at CountyCare (Chicago): One best practice for CountyCare has been utilizing a multi-prong strategy at every entry point for the member focusing on awareness (members/providers/staff), training (enrollment staff), engagement (members and providers) and action (community events).

Paul Crowley. Senior Vice President, Segments & Product at Medica (Minnetonka, Minn.): Medica has focused and prioritized a community based approach to make sure every current Medicaid member that will lose coverage, knows the resources available to them to fully understand their options. We have worked closely with state Medicaid departments, community members and directly with our members to have information and open lines of communication. This will continue and we will adjust as the redeterminations start and continue through the enrollment period.

Mac Davis. Vice President of Digital Product and Data at Belong Health (Philadelphia): Not exactly a best practice, but more of a reminder. Do not forget about your dual-eligible population! Medicaid redeterminations have an outsized impact on members in D-SNP plans. Losing Medicaid eligibility will disrupt not only continuity of care with their D-SNP plan providers, but also the important relationship with care managers who help coordinate their care. Because this population is typically more complex and high needs, it's important that we reduce churn as much as possible.

Johanna Vidal-Phelan, MD. Chief Medical Officer, Quality and Pediatrics of UPMC Health Plan (Pittsburgh): UPMC developed a comprehensive strategy to assist Medicaid recipients throughout the unwinding period. UPMC Health Plan's multichannel approach focuses on proactively reminding members about the Medicaid renewal, supporting them with renewal resources, and educating members about alternative healthcare coverage options if they lose Medicaid eligibility. Of particular importance are our nine Connect Center retail locations, including the UPMC Health Plan Neighborhood Center in Pittsburgh, that have enabled a highly personalized, community-driven and data-supported initiative to "meet Medicaid members where they are" and help them update contact information, renew their applications for Medicaid coverage, and understand the availability of alternative options. Assistance is available not only to those covered by UPMC for You, a Medicaid managed care plan that is part of a family of insurance and benefit management products offered by UPMC, but any impacted Medicaid recipient, regardless of their coverage plan.

Robert Groves, MD. Chief Medical Officer at Banner|Aetna (Phoenix): Medicaid redeterminations are underway and our approach, as a payer, is to make sure that those disenrolled know that affordable options exist in our individual market plans. We've priced to be the lowest cost option for silver plans across three Arizona counties. The question we are constantly asking is how best to reach populations. Broad media coverage and persistence seem like the smart moves.

Angela Jenkins. Vice President of Accountable Communities at Prisma Health (Greenville, S.C.): The main concern from our state health department, South Carolina Department for Health and Human Services (SCDHHS), is the lack of accurate/current address for the beneficiaries. We were provided posters with QR codes for beneficiaries to update their demographics. This was distributed to hospital facilities and medical groups throughout the state for posting in patient-facing areas (waiting rooms, treatment rooms, etc.) Additionally,  Prisma Health has implemented a text messaging campaign and sent messages to patients via Epic messaging to all Medicaid beneficiaries with information about the redetermination and need to update contact information with SCDHHS. 

Brian Li. System Director of Community Health Strategic Initiatives at CommonSpirit Health (Chicago): CommonSpirit is working really hard to help our Medicaid patients through the redetermination process, amplifying information however we can. Awareness is key here as we do not want any Medicaid patient to be left unaware of the redetermination process or their options for coverage. Here are some examples of what the divisions are doing to share the message:

  • Posters and other signage in our care sites
  • Direct mail/emails to Medicaid patients
  • Partnering with the state, Medicaid managed care plans and community partners in our communities to raise awareness

Hilary Marden-Resnik. President and CEO at UCare (Minneapolis): UCare has been working in lockstep with regulators, counties, community partners and healthcare providers to assist Medicaid members through the redetermination process. A best practice we recommend is to provide application assistance in the individual's preferred language with multilingual staff — including conference calls with county workers who can clarify verification needs. This assistance is vital because the application process is complicated, and even more so for individuals with language barriers. Collaborating with and supporting local navigator organizations, clinics and community organizations to increase outreach and application assistance capacity is vital. Earlier this year, UCare provided grants to 16 local organizations to help them build capacity.

Additional best practices are:

  • Knowing the members' renewal dates and providing timely reminders
  • Providing resources in preferred languages, including interpreter assistance with county forms
  • Keeping an open line of communication and good relationships with Medicaid regulators, while staying nimble with strategies as new requirements emerge

Jack Shoemaker. Business Operations Delivery Lead at Medical Home Network (Chicago): At MHN, we inform Medicaid beneficiaries, our community health center partners and local employers about the redetermination process with the aim of avoiding any lapses in coverage. By promoting education to both beneficiaries and those who touch their lives in some way, we ensure that there is consistency and repetition in messaging. There is no wrong channel for this messaging. We partner with local experts to develop multimodal media campaigns that promote this consistent and repetitive messaging as broadly as possible.

Praveen Thadani. President at Priority Health (Grand Rapids, Mich.): In order to educate and inform Medicaid members of the renewal process, Priority Health has found it helpful to use a wide variety of communication mediums and activities to maximize our reach. We are not relying on one particular channel of communication, but are leveraging all platforms to meet members where they're at — from social media campaigns, to mass and targeted emails, personalized mailings, individualized phone outreach, text messages, on-the-ground presence at local organizations, participation in community events, visits by community health workers, and more. We're utilizing messaging provided by the Michigan Department of Health and Human Services (MDHHS) in all of our efforts with the hope of raising awareness of this important Medicaid redetermination initiative.

Howard Weiss. Vice President of Public Policy and Government Engagement at EmblemHealth (New York City): Work with community partners. As a health plan, this means working closely with physicians and other clinicians to ensure their patients know how to renew their Medicaid eligibility or find other coverage. For example, EmblemHealth has provided our network physicians with tools they can use to help their patients maintain coverage, including lists of individuals under their care who are scheduled for redeterminations within the next three months and checklists to share with their patients describing the necessary steps to navigate the redetermination process successfully. We also work through our Neighborhood Care Centers — 13 customer care locations throughout New York City and Long Island offering health classes, sponsoring food markets, and providing other social service supports — to help individuals maintain affordable access to the health insurance they need.

Cameual Wright, MD. Vice President and Market Chief Medical Officer, Indiana, at CareSource (Dayton, Ohio): Millions of Medicaid members are at risk for losing coverage as continuous coverage policies, adopted during the public health emergency, unwind. It is critical for us, as a managed care entity, to educate members on the redetermination process and provide resources to help them maintain coverage. As contacting members through traditional means is often challenging, we have found a best practice to be collaborating with community-based organizations, who are embedded in the neighborhoods in which our members live and are viewed as trusted voices. These organizations have assisted us by educating their [communities] on the redetermination process and the steps necessary to re-establish eligibility. One such organization is even going door to door in their community to provide relevant education and materials. Leveraging the existing relationships that these organizations have with local residents have proven to be a successful avenue for member outreach.

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